Life-Threatening Complication of Percutaneous Transthoracic Fine-Needle Aspiration Biopsy: Systemic Arterial Air Embolism

Abstract

Computed tomography-guided percutaneous transthoracic fineneedle aspiration biopsy of lung lesions is a well known diagnostic technique. Nevertheless, it has some complications; such as pneumothorax, intraparenchymal hemorrhage and hemoptysis, which are not rare. Air embolism is one of the rare but potentially fetal complications of this procedure. Herein, we report the case of a 69-year-old male, in which case of systemic air embolism developed after the performance of lung biopsy. Early diagnosis and prompt oxygen therapy is crucial for patient's survival so careful reviewing of the obtained computed tomography images during the biopsy may prevent a missing systemic air embolism and provide an adequate therapy.

Nonfatal Systemic Air Embolism: A Grave Complication of Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy

“…Although there are many reported cases of air embolism caused by CT-guided TTNB, we did not find any described case of transient myocardial ischemia presented with a transient depression of the ST segment. Furthermore, up to this point, a higher incidence of iatrogenic bronchial-venous fistula was not associated with bioptic procedures involving small lesions due to penetration of healthy lung tissue [5,[7][8][9][10]. In summation, we presented a case of air embolism most likely caused by formation of the fistula.…”

“…The clinical presentation is similar to that of thromboembolic stroke syndrome, ranging from focal neurological deficits of rapid onset such as hemiplegia, confusion, or convulsions. Coronary artery air embolism can induce ECG changes typical of ischemia and infarction, dysrhythmias, and cardiac arrest [5,[7][8][9][10]. Systemic air embolism is a rare but severe complication of TTNB.…”

“…During the non-coaxial cutting needle biopsy technique, used at our institution, the previously described mechanism is not possible because the cutting needle prevents the entry of atmospheric air. The other possible way of the entry of air is the formation of a communication between air spaces inside the lungs, such as pulmonary cysts, bullae, cavitations, bronchi, and the pulmonary vein, and this complication is termed as an iatrogenically formed communicating fistula [8,10]. It is widely considered that the factors that lead to the increase of air pressure inside the airspace of the lungs, such as coughing, Valsalva maneuvers, or positive pressure ventilation, also increase the risk of air embolism.…”

“…However, a wide variety of complications may occur during TTNB such as pneumothorax, perifocal intraparenchymal bleeding, hemoptysis, hemothorax, infection, massive pulmonary hemorrhage, and air embolism [2][3][4][5][6][7]. Among them, systemic air embolism is the least common but a serious complication because it may manifest in coronary and cerebral arteries resulting in myocardial infarction, dysrhythmias, cardiac arrest, and ischemic cerebral strokes, usually with a fatal outcome [6][7][8][9]. We herein present a nonfatal systemic air embolism as a rare complication of a TTNB of a subpleural nodule in the right upper pulmonary lobe of a patient with hemoptysis.…”

Cardiac Arrest as a Consequence of Air Embolism: A Case Report and Literature Review

“…Cardiac arrest because of air embolism is an extremely rare but life threatening complication of CT guided transthoracic lung biopsies. Few cases of fatal cardiac arrest complicating transthoracic lung biopsy were reported [18–21]. A recent large multicenter case control study done in Japan looked at the risk factors for the development of systemic air embolism after CT guided lung biopsies.…”